Department of Pharmacy Practice and Science, The University of Arizona College of Pharmacy, Tucson, AZ 85721, USA.
Med Care. 2010 Oct;48(10):923-33. doi: 10.1097/MLR.0b013e3181e57962.
One approach postulated to improve the provision of health care is effective utilization of team-based care including pharmacists.
The objective of this study was to conduct a comprehensive systematic review with focused meta-analyses to examine the effects of pharmacist-provided direct patient care on therapeutic, safety, and humanistic outcomes.
The following databases were searched from inception to January 2009: NLM PubMed; Ovid/MEDLINE; ABI/INFORM; Health Business Fulltext Elite; Academic Search Complete; International Pharmaceutical Abstracts; PsycINFO; Cochrane Database of Systematic Reviews; National Guideline Clearinghouse; Database of Abstracts of Reviews of Effects; ClinicalTrials.gov; LexisNexis Academic Universe; and Google Scholar. Studies selected included those reporting pharmacist-provided care, comparison groups, and patient-related outcomes. Of these, 56,573 citations were considered. Data were extracted by multidisciplinary study review teams. Variables examined included study characteristics, pharmacists' interventions/services, patient characteristics, and study outcomes. Data for meta-analyses were extracted from randomized controlled trials meeting meta-analysis criteria.
A total of 298 studies were included. Favorable results were found in therapeutic and safety outcomes, and meta-analyses conducted for hemoglobin A1c, LDL cholesterol, blood pressure, and adverse drug events were significant (P < 0.05), favoring pharmacists' direct patient care over comparative services. Results for humanistic outcomes were favorable with variability. Medication adherence, patient knowledge, and quality of life-general health meta-analyses were significant (P < 0.05), favoring pharmacists' direct patient care.
Pharmacist-provided direct patient care has favorable effects across various patient outcomes, health care settings, and disease states. Incorporating pharmacists as health care team members in direct patient care is a viable solution to help improve US health care.
提高医疗保健服务水平的一种方法是有效利用团队式医疗服务，包括药剂师。
本研究的目的是进行全面的系统评价，并进行重点荟萃分析，以考察药剂师提供的直接患者护理对治疗、安全和人文结局的影响。
从建库到 2009 年 1 月，我们检索了以下数据库：NLM PubMed；Ovid/MEDLINE；ABI/INFORM；Health Business Fulltext Elite；Academic Search Complete；International Pharmaceutical Abstracts；PsycINFO；Cochrane Database of Systematic Reviews；National Guideline Clearinghouse；Database of Abstracts of Reviews of Effects；ClinicalTrials.gov；LexisNexis Academic Universe；和 Google Scholar。入选的研究报告了药剂师提供的护理、对照组和患者相关结局。从这些研究中，我们考虑了 56,573 个引文。多学科研究审查小组提取数据。检查的变量包括研究特征、药剂师的干预措施/服务、患者特征和研究结局。符合荟萃分析标准的随机对照试验的数据用于荟萃分析。
共纳入 298 项研究。在治疗和安全结局方面发现了有利的结果，荟萃分析对糖化血红蛋白、低密度脂蛋白胆固醇、血压和药物不良事件有显著影响（P < 0.05），有利于药剂师的直接患者护理而非对照服务。人文结局的结果有利但存在差异。药物依从性、患者知识和生活质量-一般健康的荟萃分析有显著影响（P < 0.05），有利于药剂师的直接患者护理。
药剂师提供的直接患者护理对各种患者结局、医疗保健环境和疾病状态都有有利影响。将药剂师作为直接患者护理的医疗团队成员纳入其中，是改善美国医疗保健的可行解决方案。
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